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Inhaled pentamidine shows promise for treating mild mucosal leishmaniasis, offering a well-tolerated option. However, patients with moderate to severe disease experienced relapses, necessitating extended follow-up to detect recurrences.

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Area of Science:

  • Infectious Diseases
  • Pharmacology
  • Tropical Medicine

Background:

  • Aerosolized pentamidine is FDA-approved for Pneumocystis pneumonia, with no systemic absorption or toxicity.
  • Mucosal leishmaniasis, an infection of the respiratory tract, is caused by Leishmania parasites.
  • Leishmania parasites are known to be susceptible to pentamidine.

Purpose of the Study:

  • To evaluate the efficacy and safety of aerosolized pentamidine for treating mucosal leishmaniasis.
  • To assess the treatment outcomes in patients with varying disease severities.
  • To determine the optimal follow-up duration for mucosal leishmaniasis patients treated with aerosolized pentamidine.

Main Methods:

  • A pilot study involving 15 patients with mucosal leishmaniasis caused by Bolivian Leishmania braziliensis.
  • Patients received aerosolized pentamidine (300 mg daily for 10 days over approximately 4 weeks).
  • A 2-year follow-up period was implemented to monitor treatment outcomes and detect relapses.

Main Results:

  • Six of seven patients with mild disease achieved a cure.
  • Three of four patients with moderate disease relapsed between 18 and 24 months.
  • Three of four patients with severe disease experienced early treatment failure.

Conclusions:

  • Inhaled pentamidine appears to be a well-tolerated treatment for mild mucosal leishmaniasis.
  • Relapse is a concern for patients with moderate to severe mucosal leishmaniasis.
  • A 2-year follow-up is recommended for mucosal leishmaniasis to effectively rule out relapse.